Learning to Live, Learning to Die

Shadows are fallin' and I'm runnin' out of breath

Keep me in your heart for a while

If I leave you it doesn't mean I love you any less

Keep me in your heart for a while

–Zevon & Calderón (2003)

Our challenge, our existential obligation, is to create a human life. To learn how to live in this world as a human creature, a “human being.” What we often don't realize, until we are confronting our own mortality, either through personal experience or the experiences of our patients, is that the life of a “human being” is temporary, finite, and ends. Therefore the creation of a human life is, by definition, the creation of a life that requires us to develop a relationship and attitude toward death as we create the attitudes and relationships that make life worth living and meaningful. Thus death must also become meaningful, significant, and purposeful. We must constantly, in the act of creating our lives, simultaneously learn how to live and how to die.

Some 200 years ago, Kierkegaard taught us profound lessons (Kierkegaard, 1983) about the nature of human existence. He taught us that human beings were perhaps unique amongst creatures in that we are aware of our existence. We can objectively contemplate ourselves. This awareness that we “exist” results in two emotional reactions: the emotion of “awe” and the emotion of “dread.” Simultaneously, we are struck by the beauty and awe of life as well as dread, the reality that we must die and that death can occur at any moment. “Awe” and the beauty of the experience of living a human life would appear to be a driving force of the will to live and to create a life of love, connection, attitudes, and relationships to each other, the world, something greater than ourselves and to life itself. But “dread” is a constantly present reality. It is at the essence of human existence and the nature of a human life. Clearly, we can only create a human life, live as a human being, if we develop an attitude and relationship to death that allows or enhances the experience of life in relation to death. A human life in which we can view death as acceptable and as explicable as the unexpected fact of our existence. Certainly humankind has struggled with this challenge since homo sapiens first appeared on earth (Becker, 1973; Yalom 2008).

The realization that we exist compels us to answer the existential obligation of responsibility; responding to the fact of our existence by creating a human life. We are called upon to create a life that is unique to us, in which we live to our fullest potential, a life of meaning, direction, significance, and transformation. A life in which we become a “who” in the world, in which we become a “someone” who embodies a set of values and virtues and attitudes toward the world and existence. Creating a human life, becoming a human being, becoming a “who” requires developing connections, relationships, and attitudes; toward life itself, others, loved ones, ourselves, our past, present, and future, and something/someone greater than ourselves. Creating a human life also requires creating the development of a relationship and an attitude toward death. Because a human life, living as a human being, is by definition a life in which death is an integral and immutable defining experience and fact. We must constantly learn to die as we learn to live.

Lessons on living and dying from Martin Heidegger and Warren Zevon

Heidegger (1962) wrote “If I take death into my life. Acknowledge it, and face it squarely, I will free myself from the anxiety of death and the pettiness of life—and only then will I be free to become myself.” Heidegger also wrote extensively about the concept of “being-toward-death.” The concept is often misinterpreted or not clearly understood. The way I understand the concept is as follows: our death is inevitable. It is inherent to living a human life. But, with few exceptions, one never knows when or how death is going to come. This should not encourage us to view death as some distant or intellectual concept, something that is not yet “present at hand.” Instead being-toward-death understands that one's individual death is already part of one. Therefore, the imperative is to live life fully, authentically, and with urgency. It also suggests that the need to develop an attitude and relationship toward death must begin before life is threatened by age, infirmity, or a life-threatening illness. One not only needs to learn how to live, but also learn how to live knowing death is inevitable; therefore, one must learn how to die. One must learn how to view death as a milestone of life that can serve to teach one the value of life, and to teach others how to live a finite mortal life and how to die with dignity, courage, and meaning. To live life fully despite the fact of death. To have the courage to live and love despite the inevitability and unpredictable timing of death. To be creative and loving in the face of death.

I am writing this editorial on September 7, 2018, the 15th anniversary of the death of Warren Zevon, an American rock singer and songwriter who had a cult following that included intellectual “bad boys” growing up in the 1970s and early 1980s, like me. Zevon's music was personal, sometimes melodic, profound, but always raw and emotionally honest. If you recall songs like “Werewolves of London,” “Excitable Boy,” and Linda Ronstadt's “Poor Pitiful Me,” then you know the work of Warren Zevon. He grew up in Chicago, the son of a Jewish immigrant from Russia whose original surname was Zivotovsky. His mother was a Mormon. At age 13, a musical prodigy, he studied with Igor Stravinsky. In 2002, he was diagnosed with pleural mesothelioma. Although he eventually undertook aggressive treatment for his cancer, Zevon put off treatment for a brief period to begin recording his final album, The Wind (Zevon, 2003). The recording of this final album involved collaborations with Bruce Springsteen, Jackson Browne, Tom Petty, and many other rock and roll luminaries, and much of it was completed while Zevon was weak from chemotherapy treatments. The album won two Grammy awards, including one for the song “Keep Me in Your Heart.” In this song, Zevon writes “if I leave you it doesn't mean I love you any less.” In an interview a few months before his death, Zevon was asked if he knew something more about life and death now that he was terminally ill. He replied “I suppose I've learned that, in life, you have to enjoy every sandwich.” Warren Zevon, facing inescapable, inevitable death, knew that what would make his death meaningful was to continue to love and to create, to be who he was, despite the losses and sadness and suffering. He did what he loved to do. He was being Warren Zevon, affecting the world with songs of love and courage and wisdom. He made the last days of his life meaningful and he made his death meaningful. I don't know if there's a rock and roll heaven, but if there is, Warren Zevon is playing the keyboards, composing, and singing.

If you believe in forever,

then life is just a one night stand,

if there's a rock and roll heaven

well you know they've got a hell of a band.

–O'Day & Stevenson (1973)